Kid's Camp Staff Application

Please fill out this application and information form as completely as you can. Please be advised that as a staff worker at a children's camp, the State of Michigan requires you to supply:

1) three positive character recommendations from someone other than a relative;

2) these statements denying ever having been convicted of a felony, or any type of child abuse;

3) proof of negative tuberculosis test within the last 36 months is needed for cooks and kitchen helpers.

Please identify and describe yourself:

First Name

Last Name

Date of Birth

Sex Male Female

Please provide the following contact information:

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone w/area code

Home Phone w/area code

E-mail

Which position do you want to apply for?

Please See Staff Manual for qualifications for each position.

Which week of camp do you want to attend? Choose one of the following options:

Week 1 (July 12-19)
Week 2 (July 19-26)

Enter your Home Congregation in the space provided below.

To which church (es) have you been a member of in the last 5 years?

Church Name

City and State

Have you been involved in children's ministries at your church?

Yes
No

If yes, please describe what types of children's ministries you have been involved with in the last 5 years:

Have you been convicted of anything other than a minor traffic violation?

Yes
No
Yes and I would like to talk with the superintendent

If yes, please describe below:

Have you ever been arrested or convicted of sexual or physical abuse of children?

Yes
No
Yes, and I would like to talk to the superintendent

If yes, please describe below:

References:

Reference 1: Reference 2: Reference 3:

Name

Organization

Title

Contact Phone

Revised: 04/20/08

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